| NPI | 1902105984 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHAD MATONE Doctor 1501-821-2214 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302R00000X Health Maintenance Organization (Licence: AR 2534) |
| Enumeration Date | 2011-03-16 |
| Last Update Date | 2011-03-16 |